COVID-19 Daily: Hospitals Struggle, Revisiting Vent Protocols

Here are the coronavirus stories Medscape's editors around the globe think you need to know about today:

Hospital Survey Reveals Struggles

Hospitals across the US encountered severe challenges from COVID-19 cases in late March, according to a report from the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS). Hospitals reported challenges such as delays in receiving coronavirus test results that caused staff to use personal protective equipment (PPE) with patients that turned out to not have COVID-19.

Revised Ventilator Protocols Proposed

COVID-19 patients in intensive care units in northern Italy had an atypical acute respiratory distress syndrome (ARDS) presentation with severe hypoxemia and well-preserved lung gas volume, clinicians at the Medical University of Göttingen in Germany write in a letter to the editor published in the American Journal of Respiratory and Critical Care Medicine. They suggest that instead of high positive end-expiratory pressure (PEEP), physicians should consider the lowest possible PEEP and gentle ventilation-practicing patience to "buy time with minimum additional damage."

In an editorial accepted for publication in Intensive Care Medicine, the clinicians explained further that ventilator settings should be based on physiological findings–with different respiratory treatment based on disease phenotype rather than using standard protocols.

"This of course is a conceptual model, but based on the observations we have this far, I don't know of any model which is better," one of the physicians told MDedge News.

Challenges in PPE Training, Effectiveness

When hospitals are trying to conserve personal protective equipment (PPE), infection control can be an evolving mix of science and make-do necessity — and workers must use PPE properly for it to be effective. Yet a 2018 study in the United Kingdom showed that even after workers went through simulator training, contamination was commonplace.

CDC Surveillance Reports

The US Centers for Disease Control and Prevention (CDC) has modified some of its existing disease surveillance systems to monitor COVID-19 and will publish weekly COVID-19 surveillance reports with information about laboratory testing, visits to outpatient facilities and emergency departments, hospitalizations, and deaths. In the agency's first report last Friday, it said the overall cumulative hospitalization rate is 4.6 per 100,000, and the percentage of deaths attributed to pneumonia and influenza is 8.2% — above the epidemic threshold of 7.2%.

COVID-19 in Children

Early data suggest that COVID-19 is less severe in children than in adults, but children with underlying illnesses may be at greater risk, according to experts writing in the journal JAMA Pediatrics. Less than 2% of nearly 150,000 COVID-19 cases in the US from mid-February to early April occurred in children under 18 years of age, the CDC reports.

Boris Johnson in Intensive Care

UK Prime Minister Boris Johnson has been moved to intensive care after his COVID-19 symptoms worsened, his office announced Monday. He'd been admitted to the hospital for testing Sunday evening.

Ivermectin Tested In Vitro

The broad spectrum antiparasitic drug ivermectin reduced the amount of SARS-CoV-2 viral RNA present in cell samples 48 hours after dosing, researchers from Monash University in Australia report in the journal Antiviral Research. Previous in vitro studies have found ivermectin to be active against a range of viruses, but these signals haven't always borne out in subsequent studies in mice and in the clinic.

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk of infection. Hundreds throughout the world have died.

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form.

Ellie Kincaid is Medscape's associate managing editor. She has previously written about healthcare for Forbes, the Wall Street Journal, and Nature Medicine.

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